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Dissociative Fugue
DSM-III In DSM-III, this disorder is called Psychogenic Fugue Diagnostic Criteria A'''. Sudden unexpected travel away from one's home or customary place of work, with inability to recall one's past. '''B. Assumption of a new identity (partial or complete). C'''. The disturbance is not due to an Organic Mental Disorder. '''Differential Diagnosis Organic Mental Disorders Organic Mental Disorders usually involve a disturbance of memory more marked for recent than for remote events; the memory disturbance is not isolated and disappears slowly, if at all; memory rarely is fully restored. Disturbances of attention, clouding of consciousness, and affective disturbances are usually present but unexpected travel is unusual. If travel occurs as part of an Organic Mental Disorder, it is usually not of a complex, purposive, or socially adaptive nature and appears to be mere wandering. Temporal love epilepsy When temporal lobe epilepsy involves travel, motoric activity is usually simple rather than complex and there is no assumption of a new identity. Affect is dysphoric. Typically, temporal lobe epilepsy is not precipitated by a psychosocial stress. Psychogenic Amnesia In Psychogenic Amnesia, sudden failure to recall important personal events, including one's eprsonal identity, occurs; but purposeful travel and the assumption of a new identity, partial or complete, are not present. Malingering Malingering, in which there is feigned inability to recall one's previous activity and identity, is exceedingly difficult to distinguish from Psychogenic Fugue. Careful questioning under hypnosis or during an amytal interview can be useful. DSM-IV Diagnostic Criteria A'''. The predominant disturbance is sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past. '''B. Confusion about personal identity or assumption of a new identity (partial or complete). C'''. The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy). '''D. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Differential Diagnosis General Medical Condition and Substance-Related Disorders Dissociative Fugue must be distinguished from symptoms that are judged to be the direct physiological consequence of a specific general medical condition (e.g., head injury). This determination is based on history, laboratory findings, or physical examination. Individuals with complex partial seizures have been noted to exhibit wandering or semipurposeful behavior during seizures or during postictal states for which there is subsequent amnesia. However, an epileptic fugue can usually be recognized because the individual may have an aura, motor abnormalities, stereotyped behavior, perceptual alterations, a postictal state, and abnormal findings on serial EEGs. Dissociative symptoms that are judged to be the direct physiological consequence of a general medical condition should be diagnosed as Mental Disorder Not Otherwise Specified Due to a General Medical Condition. Dissociative Fugue must also be distinguished from symptoms caused by the direct physiological effects of a substance. Other Dissociative Disorders and Manic Episodes If the fugue symptoms only occur during the course of Dissociative Identity Disorder, Dissociative Fugue should not be diagnosed separately. Dissociative Amnesia and Depersonalization Disorder should not be diagnosed separately if the amnesia or depersonalization symptoms occur only during the course of a Dissociative Fugue. Wandering and purposeful travel that occur during a Manic Episode must be distinguished from Dissociative Fugue. As in Dissociative Fugue, individuals in a Manic Episode may report amnesia for some period of their life, particularly for behavior that occurs during euthymic or depressed states. However, in a Manic Episode, the travel is associated with grandiose ideas and other manic symptoms and such individuals often call attention to themselves by inappropriate behavior. Assumption of an alternate identity does not occur. Schizophrenia Peripatetic behavior may also occur in Schizophrenia. Memory for events during wandering episodes in individuals with Schizophrenia may be difficult to ascertain due to the individual's disorganized speech. However, individuals with Dissociative Fugue generally do not demonstrate any of the psychopathology associated with Schizophrenia (e.g., delusions, negative symptoms). Malingering Individuals with Dissociative Fugue usually score high on standard measures of hypnotizability and dissociative capacity. However, there are no tests or set of procedures that invariably distinguish true dissociative symptoms from those that are malingered. Malingering of fugue states may occur in individuals who are attempting to flee a situation involving legal, financial, or personal difficulties, as well as in soldiers who are attempting to avoid combat or unpleasant military duties (although true Dissociative Fugue may also be associated with such stressors). Malingering of dissociative symptoms can be maintained even during hypnotic or barbiturate-facilitated interviews. In the forensic context, the examiner should always give careful consideration to the diagnosis of malingering when fugue is claimed. Criminal conduct that is bizarre or with little actual gain may be more consistent with a true dissociative disturbance. DSM-5 See Dissociative Amnesia